Phosphate Kinetics in Hemodialysis: Application of Delayed Pseudo One-Compartment Model

Poleszczuk, Jan; Dębowska, Małgorzata; Wójcik-Załuska, Alicja; Książek, Andrzej; Załuska, Wojciech

doi:10.1159/000445934

Cited by 12 publications

(7 citation statements)

References 23 publications

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“…This means that phosphate clearance can be accurately predicted using creatinine as a proxy marker in PD, whereas in hemodialysis the association between phosphate and creatinine clearances is not convertible 22 . In contrast to the quasi-continuous PD treatment, the hemodialysis procedure represents a substantial disturbance that induces reactions in mineral homeostasis including phosphate inflow to extracellular space and hormonal interactions 28,29 . A 'passive solute' such as creatinine does not mimic phosphate behavior when body conditions are rapidly changing 30 .…”

Section: Discussionmentioning

confidence: 99%

Phosphate clearance in peritoneal dialysis

Dębowska

Gómez²,

Pinto

et al. 2020

Sci Rep

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In renal failure, hyperphosphatemia is common and correlates with increased mortality making phosphate removal a key priority for dialysis therapy. We investigated phosphate clearance, removal and serum level, and factors associated with phosphate control in patients undergoing continuous ambulatory (CAPD), continuous cyclic (CCPD) and automated (APD) peritoneal dialysis (PD). In 154 prevalent PD patients (mean age 53.2 ± 17.6 year, 59% men, 47% anuric), 196 daily collections of urine and 368 collections of dialysate were evaluated in terms of renal, peritoneal and total (renal plus peritoneal) phosphorus removal (g/week), phosphate and creatinine clearances (L/week) and urea KT/V. Dialytic removal of phosphorus was lower in APD (1.34 ± 0.62 g/week) than in CAPD (1.89 ± 0.73 g/week) and CCPD (1.91 ± 0.63 g/week) patients; concomitantly, serum phosphorus was higher in APD than in CAPD (5.55 ± 1.61 vs. 4.84 ± 1.23 mg/dL; p < 0.05). Peritoneal and total phosphate clearances correlated with peritoneal (rho = 0.93) and total (rho = 0.85) creatinine clearances (p < 0.001) but less with peritoneal and total urea KT/V (rho = 0.60 and rho = 0.65, respectively, p < 0.001). Phosphate removal, clearance and serum levels differed between PD modalities. CAPD was associated with higher peritoneal removal and lower serum level of phosphate than APD.

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Section: Discussionmentioning

confidence: 99%

Phosphate clearance in peritoneal dialysis

Dębowska

Gómez²,

Pinto

et al. 2020

Sci Rep

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“…During all dialysis sessions the patients remained in the supine position. The whole group of patients has already been subject of the studies on phosphate, urea, and creatinine clearances [7], phosphate kinetics [8,9], extracellular calcium mass balance [10] and transcapillary transport of fluid and proteins during HD [11,12].…”

Section: Methodsmentioning

confidence: 99%

Hemodialysis-induced changes in hematocrit, hemoglobin and total protein: Implications for relative blood volume monitoring

et al. 2019

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Background Relative blood volume (RBV) changes during hemodialysis (HD) are typically estimated based on online measurements of hematocrit, hemoglobin or total blood protein. The aim of this study was to assess changes in the above parameters during HD in order to compare the potential differences in the RBV changes estimated by individual methods. Methods 25 anuric maintenance HD patients were monitored during a 1-week conventional HD treatment. Blood samples were collected from the arterial dialysis blood line at the beginning and at the end of each HD session. The analysis of blood samples was performed using the hematology analyzer Advia 2120 and clinical chemistry analyzer Advia 1800 (Siemens Healthcare). Results During the analyzed 30 HD sessions with ultrafiltration in the range 0.7–4.0 L (2.5 ± 0.8 L) hematocrit (HCT) increased by 9.1 ± 7.0% (mean ± SD), hemoglobin (HGB) increased by 10.6 ± 6.3%, total plasma protein (TPP) increased by 15.6 ± 9.5%, total blood protein (TBP) increased by 10.4 ± 5.8%, red blood cell count (RBC) increased by 10.8 ± 7.1%, while mean corpuscular red cell volume (MCV) decreased by 1.5 ± 1.1% (all changes statistically significant, p < 0.001). HGB increased on average by 1.5% more than HCT (p < 0.001). The difference between HGB and TBP increase was insignificant (p = 0.16). Conclusions Tracking HGB or TBP can be treated as equivalent for the purpose of estimating RBV changes during HD. Due to the reduction of MCV, the HCT-based estimate of RBV changes may underestimate the actual blood volume changes.

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“…It cannot, however, describe certain phenomena observed clinically in some reports, such as differences in serum phosphorus concentration on different days of the week or intradialytic increases in serum phosphorus . If these latter phenomena are of clinical interest, other kinetic models may be more relevant . On the other hand, a pseudo‐one compartment model is the simplest model and therefore, by Occam's razor, most desirable for many applications.…”

Section: Discussionmentioning

confidence: 99%

A Pseudo‐One Compartment Model of Phosphorus Kinetics During Hemodialysis: Further Supporting Evidence

et al. 2017

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A pseudo-one compartment model has been proposed to describe phosphorus kinetics during hemodialysis and the immediate post-dialysis period. This model assumes that phosphorus mobilization from tissues is proportional to the difference between the pre-dialysis serum concentration (a constant) and the instantaneous serum concentration. The current study is exploratory and evaluated the ability of a pseudo-one compartment model to describe the kinetics of phosphorus during two short hemodialysis treatments separated by a 60-min inter-treatment period without dialysis; the latter is the post-dialysis rebound period for the first short hemodialysis treatment. Serum was collected frequently during both hemodialysis treatments and the inter-treatment period to assess phosphorus kinetics in 21 chronic hemodialysis patients. Phosphorus mobilization clearance and pre-dialysis central distribution volume were previously estimated for each patient during the first hemodialysis treatment and the inter-treatment period. Assuming those kinetic parameters remained constant for each patient, serum phosphorus concentrations during the second treatment were used to estimate the driving force concentration (C ) for phosphorus mobilization from tissues during the second treatment. Treatment time (117 ± 14 [mean ± standard deviation] vs. 117 ± 14 min), dialyzer phosphorus clearance (151 ± 25 vs. 140 ± 32 mL/min), and net fluid removal (1.44 ± 0.74 vs. 1.47 ± 0.76 L) were similar during both short hemodialysis treatments. Measured phosphorus concentration at the start of the second hemodialysis treatment (3.3 ± 0.9 mg/dL) was lower (P < 0.001) than at the start of the first treatment or C (5.4 ± 1.9 mg/dL). Calculated C was 4.9 ± 2.0 mg/dL, not significantly different from C (P = 0.12). C and C were correlated (R = 0.72, P < 0.001). The results from this study demonstrate that the driving force concentration for phosphorus mobilization during hemodialysis is constant and not different from that pre-dialysis, providing further evidence supporting a fundamental assumption of the pseudo-one compartment model.

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Phosphate Kinetics in Hemodialysis: Application of Delayed Pseudo One-Compartment Model

Cited by 12 publications

References 23 publications

Phosphate clearance in peritoneal dialysis

Phosphate clearance in peritoneal dialysis

Hemodialysis-induced changes in hematocrit, hemoglobin and total protein: Implications for relative blood volume monitoring

A Pseudo‐One Compartment Model of Phosphorus Kinetics During Hemodialysis: Further Supporting Evidence

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